Scam has potential to affect the nearly 2.5 million members served by the company

WHAT:

Regence members in Oregon, Washington, Idaho and Utah report they are seeing claims for services not received on their Explanation of Benefits (EOBs). The claims were filed on behalf of companies that sell nutritional supplements.

The members bought products from these companies, whose ads state: “Learn how you can get your nutritional supplements reimbursed up to 100% through your insurance provider.”

Regence issued a nationwide alert to all Blue Cross and Blue Shield plans in April, after an investigation showed that parties filing for reimbursement were submitting fraudulent claims from providers involved in the scheme. The fraudulent claims are coded for legitimate covered services such as consultations, lab and x-ray, which members did not receive. Further, the supplement companies essentially advise consumers to disregard any notes on their health plan’s EOB about coding for services, alleging the health plan is attempting to pay less for the services.

The alert affects the nearly 2.5 million members served by Regence and 100 million people nationally who are members of a Blue Cross Blue Shield health plan.

WHY:

Regence is charged with stewardship over members’ resources, including protection against con artists. Charging for services not rendered is one of the most common forms of health care fraud and abuse.

In this case, members provided the marketing companies with their Regence member identification number, so a company could bill Regence for legitimate covered services – which were not received – as a way of getting money for the vitamin supplements, which are not a covered benefit.

TIPS:

Guard your insurance benefits.Members are the first line of defense against fraud. Examine EOBs as carefully as bank and credit card statements, and report any claims for services, procedures or devices not received.

Report discrepancies to Regence Fraud Hotline, (888-207-4211) or the customer service number on your member card. This is an ongoing investigation and Regence will cooperate with law enforcement.

Know your coverage. Do not give your member number to companies that imply they can get reimbursement for goods or services not normally covered by your insurance – such as vitamins. Their activity is potentially fraudulent.